Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2023; 29(19): 3040-3047
Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.3040
Pulmonary hypertension, nephrotic syndrome, and polymyositis due to hepatitis C virus infection: A case report
Ya-Nan Zhao, Guo-Hui Liu, Chang Wang, Yi-Xuan Zhang, Ping Yang, Ming Yu
Ya-Nan Zhao, Guo-Hui Liu, Chang Wang, Yi-Xuan Zhang, Ping Yang, Ming Yu, Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Author contributions: Zhao YN and Liu GH were the patient’s physicians; Yu M reviewed the literature and contributed to manuscript drafting; Wang C and Zhang YX performed the contributed to data collection; Yu M and Yang P were responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming Yu, Doctor, Department of Cardiology, China-Japan Union Hospital of Jilin University, No. 126 Xian-tai Street, Changchun 130033, Jilin Province, China. yuming2019@jlu.edu.cn
Received: March 14, 2023
Peer-review started: March 14, 2023
First decision: April 10, 2023
Revised: April 17, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: May 21, 2023
Processing time: 62 Days and 18.2 Hours
Abstract
BACKGROUND

Hepatitis C infection not only damages the liver but also often accompanies many extrahepatic manifestations. Incidences of pulmonary hypertension (PH) caused by hepatitis C are rare, and incidences of concurrent nephrotic syndrome and polymyositis are even rarer.

CASE SUMMARY

Herein we describe the case of a 57-year-old woman who was admitted to our department for intermittent chest tightness upon exertion for 5 years, aggravated with dyspnea for 10 d. After relevant examinations she was diagnosed with PH, nephrotic syndrome, and polymyositis due to chronic hepatitis C infection. A multi-disciplinary recommendation was that the patient should be treated with sildenafil and macitentan in combination and methylprednisolone. During treatment autoimmune symptoms, liver function, hepatitis C RNA levels, and cardiac parameters of right heart catheterization were monitored closely. The patient showed significant improvement in 6-min walking distance from 100 to 300 m at 3-mo follow-up and pulmonary artery pressure drops to 50 mmHg. Long-term follow-up is needed to confirm further efficacy and safety.

CONCLUSION

Increasing evidence supports a relationship between hepatitis C infection and diverse extrahepatic manifestations, but it is very rare to have PH, nephrotic syndrome, and polymyositis in a single patient. We conducted a literature review on the management of several specific extrahepatic manifestations of hepatitis C.

Keywords: Hepatitis C; Nephrotic syndrome; Polymyositis; Pulmonary hypertension; Case report

Core Tip: Hepatitis C virus (HCV) infection should be considered a systemic disease which is often associated with many extrahepatic manifestations, but it is very rare to have multiple different extrahepatic manifestations in a single patient. In this article, we report a case of pulmonary hypertension (PH), nephrotic syndrome, and polymyositis due to HCV infection. The optimal treatment strategy for hepatitis C-related extrahepatic manifestations remains to be determined. Our case confirms sildenafil and macitentan as effective treatment option for patients suffering from PH due to hepatitis C infection. However, randomized, controlled trials are warranted to confirm the present results.